Medical Mystery Monday #29: the case of the multiple rashes

Today’s medical mystery was sent in by a reader – thank you! See if YOU can diagnose the patient below.

A disheveled young man is escorted into the Emergency Room by two police officers after they found him standing in the middle of the street yelling at passing cars. He is extremely irritable and agitated, and he refuses to let the doctor come near him. When she comes back to check on him a few hours later, he is soundly sleeping and barely arousable. The doctor decides to examine him anyway.

When checking his vital signs, she finds that he has a high fever; he also appears to be sweating and shaking. When she listens to his heart, she hears a murmur in between the “lub” and the “dub” of the heart sounds, and the sound radiates to the patient’s armpit. She also notices some lesions on both of his arms (shown below). In addition, she finds multiple different skin rashes: under the patient’s fingernails, on the soles of his feet, and the palms of his hands (shown below).